Hospital Compare Q and As

How Can I Use Hospital Quality Information?

This information tells you about the quality of certain hospital services. It shows how quality of care can vary between hospitals. Currently, the quality information relates to the care given for patients with three serious medical conditions that are common for adults, especially in people with Medicare:

heart attacks,
heart failure, and
pneumonia

It shows how often the hospitals provide the type of care considered to be the standard. Information on other illnesses and conditions will be added later.

This information can let you see what treatments are usually given, and how well the participating hospitals give these treatments to patients with specific conditions. This can help you when talking to your doctor or other health care professional about the care you are getting.

What is Hospital Quality?

Hospital quality means patients get the right medicine, treatment, or test at the right time, given the patient's condition. It is important to know that hospitals vary in terms of their quality of care.

What you can do about Hospital Quality

Talk to your doctor or other health care provider about hospital quality. Some hospitals have more experience or better results treating certain conditions or performing certain procedures. Ask your doctor or health care provider which hospital has the best care and results for your condition. Ask why he or she uses that hospital.
Talk to your doctor or health care provider about other patients' experiences with the hospital. If your doctor shows a strong preference for a certain hospital, ask why.
Look at the hospital information on this website and others and talk to your doctor about any questions or concerns you have.
Ask family or friends about their hospital experiences.
Sometimes your hospital choices are limited by your location, insurance or medical needs. But if you have a choice, get as much information as you can to make it your best choice.

How Hospitals Treat Heart Attack Patients

Here are some of the best medical practices for treating a heart attack. A best medical practice is a treatment that has been proven to provide the best results for most patients. These treatments are considered an important part of the patient's overall care.

Hospitals should make sure heart attack patients:

take aspirin within 24 hours of arriving at the hospital unless taking aspirin could be harmful (such as if the patient has an ulcer). Hospitals should also make sure heart attack patients are told to continue to take aspirin when they leave the hospital.
are given a beta blocker (a medicine to treat some heart problems) within 24 hours of arriving at the hospital. Hospitals should also make sure heart attack patients are prescribed a beta blocker when they leave the hospital.
are given an ACE Inhibitor (a medicine that treats some heart problems) before they leave the hospital.
are given thrombolytics, a medicine to dissolve blood clots, within 30 minutes of arriving at the hospital.
are given a procedure to open blocked blood vessels within 90 minutes of arriving at the hospital.
if they are smokers, are given information about quitting smoking before they leave the hospital.

How Hospitals Treat Heart Failure Patients

Here are some of the best medical practices for treating heart failure. A best medical practice is a treatment that has been proven to provide best results for most patients. These treatments are considered an important part of the patient's overall care.

Hospitals should make sure heart failure patients:

have their hearts checked to see how the left chamber is pumping (left ventricular function assessment).
are prescribed an ACE Inhibitor (a medicine that treats some heart problems) when leaving the hospital.
are given instructions for how to manage their symptoms on their own, before they are discharged.
if they are smokers, are given information about quitting smoking before they leave the hospital.

How Hospitals Treat Pneumonia Patients

Here are some of the best medical practices for treating pneumonia. A best medical practice is a treatment that has been proven to provide the best results for most patients. These treatments are considered an important part of the patient's overall care.

Hospitals should make sure pneumonia patients:

oxygen levels in the patient's blood are measured by doing an oxygenation assessment within 24 hours of the patient's arrival at the hospital.
are given an antibiotic, or combination of antibiotics, to treat pneumonia as soon as possible, unless they are allergic to antibiotics.
are given a pneumonia vaccine if they have not had one, before they leave the hospital.
are given a blood culture on arrival.
if they are smokers, are given information about quitting smoking before they leave the hospital.

Why Are These Treatments Important?

ACE Inhibitor

ACE inhibitors are a type of medicine used to treat some heart problems. ACE inhibitors can help reduce the risk of death from a heart attack if taken within 24 hours of the first symptoms of a heart attack. Continued use may help prevent or treat heart failure. ACE inhibitors work by stopping the production of a hormone (angiotensin II) that can narrow blood vessels. This helps reduce the pressure in the heart, improve heart function, and lower blood pressure.

Hospitals should make sure that patients with a heart attack or heart failure are getting an ACE inhibitor if they need it.

Antibiotic timing

Antibiotics are a type of medicine used to treat the kind of pneumonia caused by bacteria. Early treatment with antibiotics can cure bacterial pneumonia and reduce the possibility of complications.

Hospitals should make sure that patients with bacterial pneumonia get an antibiotic or combination of antibiotics as soon as possible.
If the patient is allergic to antibiotics, hospitals can give another medicine to treat pneumonia.

Aspirin

Taking an aspirin (chewed if possible) as soon as symptoms of a heart attack begin may help reduce the severity of a heart attack. Aspirin can help prevent blood clots from forming or help dissolve blood clots that have formed. Following a heart attack, continued use of aspirin may help reduce the risk of another heart attack.

Aspirin can have side effects like

stomach inflammation,
bleeding, or
allergic reactions.

A patient with a stomach ulcer or an allergy to aspirin should not take aspirin. Talk to your doctor before using aspirin on a regular basis.

Hospitals should make sure that patients with a heart attack take an aspirin within 24 hours of arriving at the hospital and are told to continue to take aspirin after leaving the hospital. If the patient can't take aspirin (for instance, if they have an ulcer), the hospital should make sure they are taking a medicine that will give a similar result.

Beta Blocker

Beta blockers are a type of medicine that is used to

lower blood pressure,
treat chest pain (angina) and heart failure, and
help prevent a heart attack.

Beta blockers relieve the stress on the heart by

slowing the heart rate and
reducing the force with which the heart muscles contract (to pump blood).

They also help keep blood vessels from constricting in the heart, brain or body.

Hospitals should make sure that patients with a heart attack or heart failure are given beta blockers within 24 hours of arriving at the hospital. They should also make sure patients are prescribed beta blockers or another medicine when they leave the hospital to help prevent further heart problems.

Blood culture

Different types of bacteria can cause pneumonia. A blood culture is a test that identifies which bacteria may have caused your pneumonia, so that you can be prescribed the antibiotic that seems most likely to be effective to treat it. In order to start antibiotic treatment as quickly as possible, the blood culture should take place as soon as possible after arriving at the hospital.

Hospitals should perform a blood culture on pneumonia patients within 24 hours after they have arrived at the hospital, and before antibiotic treatment is started.

Discharge instructions

Heart failure is a chronic condition. It results in such symptoms as shortness of breath, dizziness, and fatigue. If you are diagnosed with heart failure, you will need information to help you manage your symptoms after you get home.

Hospitals should make sure that patients with heart failure, before they are discharged from the hospital, receive information about how to manage their symptoms. Information should include:

activity level (what you can and can't do)
diet (what your should and shouldn't eat or drink)
medications
follow-up appointment
watching your weight daily
what to do if your symptoms get worse.

Left ventricular function assessment

A left ventricular function (LVF) assessment is a test of the left side of the heart that helps doctors find the cause of heart failure. It includes listening to the heart and ordering tests such as

a chest x-ray,
blood work, and
an echocardiogram (ECG).

If a patient has heart failure, hospitals should do a left ventricular function (LVF) assessment to find the cause.

Oxygenation assessment

An oxygenation assessment is a test to measure the amount of oxygen in your blood. Pneumonia can lower the oxygen in your blood because the air spaces in your lungs fill with fluid. The assessment may include

an ABG (arterial blood gas) or
pulse oximetry (electrodes attached to a part of your body like a finger, earlobe, or skin fold).

Hospitals should do an oxygenation assessment on all patients with pneumonia within 24 hours of arrival.

Pneumonia vaccine

A pneumonia vaccine (also known as a pneumococcal vaccination) is a shot that may help prevent or lower the risk of complications of bacterial pneumonia.

Hospitals should make sure that all patients admitted for bacterial pneumonia get a vaccine to help prevent pneumonia in the future.

PTCA (also called Percutaneous Coronary Intervention or PCI)

The heart is a muscle that needs oxygen that it gets through arteries. Most heart attacks are caused when blood clots block the arteries that bring oxygen to the heart. Restoring blood flow to the heart by opening blocked arteries as quickly as possible results in lower death rates and better recovery of the heart's mechanical function. Blood flow can be restored either by medications (thrombolytics, or "clot busters"; see below) or with certain procedures previously called PTCA and now called Percutaneous Coronary Intervention (PCI). A PCI is a group of procedures that all involve the insertion of a catheter (a flexible tube), most often in a leg, that is guided through the blood vessels to the clot that is blocking the artery. PCIs use very small balloons and other devices to then open the blocked heart arteries.

Both PTCA (PCI) and thrombolytics are effective in opening blood vessels. The hospital will determine which treatment to give a patient based on such factors as how quickly the patient was able to get to the hospital after the heart attack, whether PTCA/PCI is readily available, and the patient's wishes.

Hospitals should make sure that heart attack patients who are to receive a PTCA (PCI) should be given the treatment within 90 minutes after they arrive at the hospital.

Smoking Cessation

Smoking increases your risk for developing blood clots and heart disease, which can result in a heart attack, heart failure, or stroke. Smoking also damages your lungs and can make it hard to breathe, increasing your chances of getting pneumonia or other chronic lung diseases like emphysema and bronchitis. Smoking is also linked to lung cancer and can cause premature death. It is important for your health that you get information to help you quit smoking before you leave the hospital.

Hospitals should make sure that all patients who smoke and who are admitted for heart failure, heart attack and pneumonia are given information about how to quit smoking before they are discharged.

Thrombolytics

Both thrombolytics and PTCA (PCI) are effective in opening blood vessels. The hospital will determine which treatment to give a patient based on such factors as how quickly the patient was able to get to the hospital after the heart attack, whether PTCA/PCI is readily available, and the patient's wishes.

Hospitals should make sure that heart attack patients who are to receive thrombolytics are given the medication within 30 minutes after they arrive at the hospital.

Glossary

HEART ATTACK

A heart attack (also called an acute myocardial infarction or AMI) occurs when the arteries leading to the heart become blocked, and the blood supply is stopped. When the heart muscle can't get the oxygen and nutrients it needs, the part of the heart tissue that is affected dies. Heart attacks can last for several hours. (Seek help right away if you think an attack is beginning.) The symptoms of a heart attack can include

chest pain (often described as a crushing, squeezing or burning pain in the center of the chest and may radiate to your arm or jaw).
shortness of breath,
dizziness,
faintness,
chills,
sweating, or
nausea.

Your skin may feel cold or clammy and you may appear gray or pale and look very ill. Sometimes there are no symptoms.

PNEUMONIA

Pneumonia is an infection that fills your lungs with fluid, lowering the oxygen level in your blood. Symptoms of pneumonia can include

fever,
fatigue,
difficulty breathing,
chills,
"wet" cough (mucus may look green or bloody), and
chest pain.

HEART FAILURE

Heart failure is a weakening of the heart's pumping power that increases the pressure in the heart. Not enough oxygen and nutrients are pumped through the body to meet its needs. The heart tries to pump more blood by stretching its chambers, but the muscle walls become weaker over time.

Symptoms of heart failure may include

shortness of breath from fluid in the lungs,
swelling (such as in legs, ankles or abdomen),
dizziness,
fatigue,
weakness and
a rapid or irregular heartbeat.

Heart failure can be a result of

coronary artery disease,
a heart attack,
heart muscle damage from infection or alcohol or drug abuse, or
an overworked heart (caused, over time, by conditions like
- high blood pressure,
- kidney disease,
- diabetes, or
- a birth defect).